Today, I Could Put on My Shoes!

Throughout this illness, which appears to be Poststreptococcal Reactive Arthritis (although it could be something else), my health has been quite varied. (Also as suggested by the Long Island personal injury law firm, I have filled in some medical detail after the symptoms descriptions; mostly to clarify what PSRA is, and how and why my treatment is progressing the way it is.)

No, these aren’t my shoes, but … dang … [Enunciate the last bit the way Will Smith recommends Beatrice (Edgar’s wife) hire an internal decorator in Men in Black.]

For example, here’s how the past few days have gone:

Thursday: Ibuprofen taken at night allowed me to move fairly well in the morning. As soon as I woke up, I took my prednisone, and within a couple of hours, was able to hobble about without much pain. I had a doctor’s appointment mid-day, but worked at the office and from home around the appointment, and felt very good. By late afternoon, I had a fever, and needed to take a short nap. Still, I managed to get to and lead our small group Bible study, with Nichelle driving. I felt good, and didn’t take any extra medication at bedtime, when the prednisone was definitely beginning to wear off.

Friday: Not taking the ibuprofen seems to have been a big mistake. I awoke at about 5:00 a.m. with serious pain and movement issues. I could barely move my legs, and couldn’t use either hand. I waited until 6:00 to take the increased dose of prednisone Dr. Eranki prescribed, but it took hours to have a noticeable effect. I did go to work, but didn’t make it into the office until 11:30 a.m. Due to the pain and swelling in my left middle finger, typing on my left hand was reduced to 1-finger. Still, in the evening I felt very good. Nichelle and I were able to attend “Run for Your Wife,” a TCAN Players [hilarious] comedy play featuring co-worker Laura Crook.

Saturday: I felt good for a few hours in the morning, but spent most of the day fighting the low fever, playing some games with the kids and hanging out in Azeroth, spending an inordinate amount of time trying to beat a seasonal instance.

Sunday: Good in the morning. I was able to drive to church early for my Geek work (A/V), and even ran a couple of quick errands in Nashua after the service (pharmacy; gas for the mower). By mid afternoon, the fever was back, and I spent a couple of hours starting at supper time just sleeping. Afterward, I felt pretty good.

Today: Today I was able to move my legs well enough to put on shoes and socks for the first time in several weeks! (After taking prednisone a few hours earlier.) The biggest problem today is my left hand. I do have a low fever, but it’s only about 1/2 a degree above normal, which to me is starting to feel normal.

By this evening, my movement ability had dropped a bit, but not much, but I became febrile again enough to notice. Oh, well, today was better than usual.

PSRA Details / Symptoms / Concepts

Tomorrow will mark my fourth week since the onset of obvious symptoms, and I had noticed some minor symptoms before that. Wow!

Poststreptococcal Reactive Arthritis is only a probable diagnosis. I will have an echocardiogram in a few weeks, as well as another Lyme disease titer, to rule out Rheumatic Fever and Lyme disease, respectively.

However, PSRA does seem to fit the symptoms. Neither PSRA nor rheumatic fever are testable conditions; they are syndromes—collections of symptoms—and the symptoms must be weighed carefully to figure out what the overall diagnosis should be.

The biggest meaningful symptoms or test results have been a positive blood test for a recent strep infection, the swelling and joint pain in my legs, hands, and shoulders, the fever, and vast number of negative tests for heart problems, liver function problems, active infections, etc.

Note that arthritis essentially means joint pain, so the reactive arthritis (assuming that it what I have), is not the type of arthritis that we all tend to develop as we age. (There is some x-ray evidence of that happening in my back, which is completely normal for this point in my life, and has not affected me in any way.)

I have a few days to go on my antibiotic treatment, and have already started tapering down the prednisone. Today has been my best freedom-of-movement day so far, and I hope that trend will continue. The guys in my at-work Bible study laid hands on me and prayed for my recovery today, which was very moving.

10 Replies to “Today, I Could Put on My Shoes!”

  1. Glad to read your update, we are continuing to pray as well. As a family we seem to be branching out from just mental illness into some physical weird stuff as well! Aren’t we all special!! But wouldn’t trade anyone!

  2. I’m thinking she was referring to You with the mental illness statement Doug. Glad to hear they think they know what you got… we think we’ve finnaly got me figured out too, but will wait for MORE test results before posting. And Cindy? I think I’d trade Aaron for a new fising pole….them I wouldn’t get a call every week that starts out “Hello, Brother, I have a question for you…”

  3. I’m wondering why you aren’t/ haven’t been getting IV antibiotic therapy to knock it down rather than having to digest oral antibiotics before getting the benefit.
    Seems like with a persistant fever like that…I dunno, I’m not a doctor, either, I just play one on TV.
    And Paul, you should just keep Aaron rather than trade him for a new fishing pole. You have all the fishing poles you need in order for you not to catch any fish.
    What you need is a CATCHING pole.

  4. I don’t have an active infection, according to my blood tests and knee fluid draw, so the IV antibiotics don’t seem to be that important. The fever seems to be related to the inflammation. (I need to ask about how that works.) Lately, though, the fever has been more off than on, which is a big improvement.

    Yes, I’m actually one of the mental health cases. (Yep, it’s true.)

    Ha. I hadn’t realized Aaron starts all his phone conversations that way! My favorite is when he calls and wants me to fix his computer.

    Loved your fishing pole comments. Paul, you wouldn’t want a new fishing pole. How could you part with your pink Barbie® one? Of course, maybe I could use your reasoning at work. “I can’t get my code debugged … I need a new computer.”

    You guys might know what’s wrong with Paul (well … that list could go on and on), but won’t even hint at it? Weasels.

  5. So … my infectious disease doc is relatively certain that this is, indeed, PSRA. Just got back from an appointment with him.

    I will be re-EKG-ed and re-echo-cardiogrammed in a few weeks, to rule out acute rheumatic fever.

    Yesterday I was in pretty good shape. Today has brought slower walking and some bad finger pain (with swelling), but my leg swelling is down (though still there), and my fever seems to be more infrequent. Today is also my last day on antibiotics.

  6. Ok, as we’re still waiting on results and more test (UNGH) I guess I need to post an update too. Went last week to see Dr Felix (again) and explained to him about the whole back pain and ER deal, and told him about the testicular pain (which by the way is directly related to the back pain… the more the back hurts seems the worse the pain there is too!) at which time I went for MORE blood work and X-rays of my back, all of which came back as, yes you guessed it, normal! Now, I can’t ell you how many times now I’ve tried to explain to these Drs that the pain in my back is NOT a muscle, as you can rub it and i can bend over without any more pain. Its a pain in-behind or on top of the hip area, but they all keep giving me muscle relaxants (which still get used LOL) and pain pills…. neither of which seem to help. Standing and walking are terrible at times, to the point I stay mainly on the couch when I’m home. Dr felix has me on a antibiotic (Crystals recommendation) just in case its an infection of some sort. I will be having a WONDERFUL urologist appointment first thing Tuesday morning to see what he thinks. What ever this is, its slowly working its way thru my body, started at my neck and is now in lower back. Eventually I’m thinking it will come out my toes and I can get back to normal life!

  7. Yer mom made the observation yesterday that the back thing could be related to something congenital, citing one of the reasons Duane was given up for adoption as him having physical problems with his legs and such. I think it is entirely possible that over the last 36 years wear and tear in that area, all he had to do was sneeze wrong and he likely has ruptured some degenerated disc or something. Many times stuff like that won’t show up on an xray, it takes an MRI. I think the boys hurting is coincidental. Clarification: the antibiotics are to rule out epidydimitis which is infection/inflammation of the spermatic cord…you know…the hose what helps the baby juice make it from the juice factory to the momma eggs. (there…now you have my highly technical medical explanation even if I can’t speel to save my life) They seem to have ruled out testicular cancer (which would tie the back and the pain in the boys together) since the AFP and the HCG was negative. Yes, they do a sort of pregnancy test to check for tumors down there in guys. They would excrete the same kind of hormone as it grows as the mommy would when there is a bun in the oven. Whooda thunk it?

  8. Dang…..So sorry you and Paul are having so many issues…Glad for Blog so I can keep up with you all. Some good news here…Rich’s knee replacement seems to have finally calmed down and he is happy he had it done and is planning on other knee in a few years. I think I will get medication for myself when he gets next knee done….take care you all…and congrats to Nichelle on her continued downsizing!!! Love ya

  9. You don’t remember the epididymis line from Ghostbusters II?

    Dr. Peter Venkman (Bill Murray): Hi, Egon. How’s school? I bet those science chicks really dig that large cranium of yours, huh?

    Dr. Egon Spengler (Harold Ramis): I think they’re more interested in my epididymis.

    So, Paul is defective, eh? I didn’t realize Mom and Dad had gotten defective merchandise. Maybe there’s an extended warranty available.

    Of course, I have brain damage (really—it’s why I have no peripheral vision on the left side), so who am I to talk?

    We could discuss Aaron, too, but I don’t think my BLOG’s database is large enough.

    Next time Richard is in for a replacement, just have them tack on a personality replacement as well …

  10. [Redacted from an e-mail I sent …]

    Status Report

    Well, I’m improving, albeit very slowly. The favored diagnosis is still Poststreptococcyl Reactive Arthritis, although Rheumatic Fever is not completely ruled out of the differential.

    I still have pain, swelling, occasional fever, and movement difficulties. However, they are not bad enough to keep me from working full-time or participating in much of life. (I am, however, disappointed that I can’t get in my exercise. Going from running 1-2 miles a day to walking with a limp at best is quite a change. So, I’ve been playing more World of WarCraft with the kids, and not hitting the weights, road, or elliptical.)

    There are still days when I’m feverish and worn out, but they seem to be relatively rare. Last Saturday was one, and I spent most of the day either sleeping or in a slightly-fevered fog. Sunday, on the other hand (there may be a weather related connection), was an absolutely wonderful day, and Nichelle and I (the boys were at the Dunn’s house) took NaNi to Canobie Lake Park after church. That insane 4-year-old child was very disappointed at some of the height restrictions, but did go on and love at least one “black diamond” rated ride which I chickened out of. All in all, I managed 4-5 hours of near-constant walking or being on my feet, which may have contributed to Monday being a relatively bad day for movement.

    My treatment regimen at this point includes a dose of prednisone in the morning, which will slowly taper down over the next four weeks, acetaminophen if the fever goes up, and an 800 mg dose of ibuprofen at night. Now that the swelling isn’t as severe, the ibuprofen seems to be better up to the task of making it easier to move in the morning.

    PSRA Mechanics

    I also have an explanation of how this thing works. Essentially, it’s a case of immune system confusion. The streptococcal bacteria are antigens that the immune system identifies. The immune system responds with fighting the bacteria by producing antibodies that bind with the antigens to eliminate the bacteria, and increasing the production of white blood cells. This sometimes causing fluid to build up in affected areas. In the case of PSRA, however, the immune system’s own antigens resemble the streptococcal antigens closely enough that the immune system continues to fight the infection even after it’s gone. The prednisone acts on this by mitigating the immune response, reducing the inflammation.

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